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ON° Public Water System Onsite: LI Yes <br />III Yes 111 No Verified Chain of Custody: <br />SPOILS <br />li1No Contamination Noted: 111 Yes <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />111 Yes LINo <br />isEI-. GROUTING or DESTRUCTION Total Depth: <br />SANJOAOUIN <br />-„tiliGvi) —COUNTY <br />wreathes s grows r“-ft' <br />Monitoring Well/Soil Boring Inspection Report <br />Environmental Health Department <br />Date: L `1112% Inspector: Sci4 inti <br />Facility Address: Z,9 61 (----jp Art lorra,( lid(wo <br />Well Address: <br />WP# Li 67- Well#: <br />Soil Boring#: <br />Drilling Company: 14.6.r <br />Driller Onsite: <br />Consultant: k.)0,MO, —\LA.hL t ASSOCitak-C, , <br />Geologist: GkinZA • <br />Domestic Well Onsite: 111 Yes El No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Depth to Water: <br />Gallons of Grout Used: <br />LII Well Installation 111 Well Destruction <br />El Boring Installation Boring Destruction <br />METHOD USED <br />II Pressure Grout 1110ver Drill <br />El Gravity LlTremie CI Other: <br />Grout Material: (ik or k. <br />Water <br />gallons <br />Cement 47 lb <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest tr Bags <br />2.5 5 1 t.," 5 10 1 <br />5 10 2 L., 10 20 2 <br />7.5 V 15 ' 3 4., 15 30 3 <br />10 20 4 20 40 4 <br />12.5 25 5 25 50 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16/2017 <br />I <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I wwvv.sicehd.com <br />CONSTRUCTION <br />casing <br />height <br />ABOVE-GROUND <br />COMPLETION CHRISTY-BOX <br />COMPLETION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes IIINo <br />To: <br />To: <br />To: <br />To: <br />COMPLETION El Stove Pipe 111Christie Box <br />ft. <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: